|
PR LAVAGE CANNULATION MAXILLARY SINUS
|
Professional
|
Both
|
$359.57
|
|
|
Service Code
|
HCPCS 31000
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$305.63 |
| Rate for Payer: AlohaCare Medicaid |
$118.85
|
| Rate for Payer: AlohaCare Medicare |
$107.87
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Devoted Health Medicare |
$118.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$177.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$118.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.32
|
| Rate for Payer: Health Management Network Commercial |
$305.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.87
|
| Rate for Payer: University Health Alliance Commercial |
$151.54
|
|
|
PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE
|
Professional
|
Both
|
$347.53
|
|
|
Service Code
|
HCPCS 93462
|
| Min. Negotiated Rate |
$168.59 |
| Max. Negotiated Rate |
$295.40 |
| Rate for Payer: AlohaCare Medicaid |
$196.64
|
| Rate for Payer: AlohaCare Medicare |
$168.59
|
| Rate for Payer: Cash Price |
$208.52
|
| Rate for Payer: Cash Price |
$208.52
|
| Rate for Payer: Devoted Health Medicare |
$185.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.59
|
| Rate for Payer: Health Management Network Commercial |
$295.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$196.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.59
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$2,334.00
|
|
|
Service Code
|
HCPCS 93452 TC
|
| Min. Negotiated Rate |
$732.40 |
| Max. Negotiated Rate |
$1,983.90 |
| Rate for Payer: AlohaCare Medicaid |
$974.38
|
| Rate for Payer: AlohaCare Medicare |
$732.40
|
| Rate for Payer: Cash Price |
$1,400.40
|
| Rate for Payer: Cash Price |
$1,400.40
|
| Rate for Payer: Devoted Health Medicare |
$805.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$732.40
|
| Rate for Payer: Health Management Network Commercial |
$1,983.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$878.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$878.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$878.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$974.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$732.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$974.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$732.40
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 93452 26
|
| Min. Negotiated Rate |
$226.87 |
| Max. Negotiated Rate |
$974.38 |
| Rate for Payer: AlohaCare Medicaid |
$974.38
|
| Rate for Payer: AlohaCare Medicare |
$226.87
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Devoted Health Medicare |
$249.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.87
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$272.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$272.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$974.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$974.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.87
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$2,731.00
|
|
|
Service Code
|
HCPCS 93452
|
| Min. Negotiated Rate |
$959.27 |
| Max. Negotiated Rate |
$2,321.35 |
| Rate for Payer: AlohaCare Medicaid |
$974.38
|
| Rate for Payer: AlohaCare Medicare |
$959.27
|
| Rate for Payer: Cash Price |
$1,638.60
|
| Rate for Payer: Cash Price |
$1,638.60
|
| Rate for Payer: Devoted Health Medicare |
$1,055.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$959.27
|
| Rate for Payer: Health Management Network Commercial |
$2,321.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,151.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,151.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,151.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$974.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$959.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$974.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$959.27
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR
|
Professional
|
Both
|
$1,267.00
|
|
|
Service Code
|
HCPCS 27427
|
| Min. Negotiated Rate |
$602.94 |
| Max. Negotiated Rate |
$1,076.95 |
| Rate for Payer: AlohaCare Medicaid |
$738.29
|
| Rate for Payer: AlohaCare Medicare |
$674.91
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Devoted Health Medicare |
$742.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$674.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$602.94
|
| Rate for Payer: Health Management Network Commercial |
$1,076.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$809.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$809.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$809.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$738.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$674.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$738.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$674.91
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR
|
Professional
|
Both
|
$1,984.00
|
|
|
Service Code
|
HCPCS 27428
|
| Min. Negotiated Rate |
$840.32 |
| Max. Negotiated Rate |
$1,686.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,154.19
|
| Rate for Payer: AlohaCare Medicare |
$1,053.27
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Devoted Health Medicare |
$1,158.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,053.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$840.32
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,263.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,263.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,263.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,154.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,053.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,154.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,053.27
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$583.73
|
|
|
Service Code
|
HCPCS 37609
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$496.17 |
| Rate for Payer: AlohaCare Medicaid |
$206.04
|
| Rate for Payer: AlohaCare Medicare |
$188.10
|
| Rate for Payer: Cash Price |
$350.24
|
| Rate for Payer: Cash Price |
$350.24
|
| Rate for Payer: Devoted Health Medicare |
$206.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$206.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$322.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$188.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$206.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.16
|
| Rate for Payer: Health Management Network Commercial |
$496.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$206.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$188.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$206.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$188.10
|
| Rate for Payer: University Health Alliance Commercial |
$310.00
|
|
|
PR LIGATION INTERNAL JUGULAR VEIN
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 37565
|
| Min. Negotiated Rate |
$244.14 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: AlohaCare Medicaid |
$723.59
|
| Rate for Payer: AlohaCare Medicare |
$640.56
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Devoted Health Medicare |
$704.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$640.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$244.14
|
| Rate for Payer: Health Management Network Commercial |
$1,049.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$768.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$768.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$768.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$723.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$640.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$723.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$640.56
|
|
|
PR LIGATION MAJOR ARTERY ABDOMEN
|
Professional
|
Both
|
$2,179.00
|
|
|
Service Code
|
HCPCS 37617
|
| Min. Negotiated Rate |
$708.76 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,278.44
|
| Rate for Payer: AlohaCare Medicare |
$1,160.96
|
| Rate for Payer: Cash Price |
$1,307.40
|
| Rate for Payer: Cash Price |
$1,307.40
|
| Rate for Payer: Devoted Health Medicare |
$1,277.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,160.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$708.76
|
| Rate for Payer: Health Management Network Commercial |
$1,852.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,393.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,393.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,393.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,278.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,160.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,278.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,160.96
|
|
|
PR LIGATION MAJOR ARTERY CHEST
|
Professional
|
Both
|
$1,907.00
|
|
|
Service Code
|
HCPCS 37616
|
| Min. Negotiated Rate |
$667.16 |
| Max. Negotiated Rate |
$1,620.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,096.57
|
| Rate for Payer: AlohaCare Medicare |
$1,047.89
|
| Rate for Payer: Cash Price |
$1,144.20
|
| Rate for Payer: Cash Price |
$1,144.20
|
| Rate for Payer: Devoted Health Medicare |
$1,152.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,047.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$667.16
|
| Rate for Payer: Health Management Network Commercial |
$1,620.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,257.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,257.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,257.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,096.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,047.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,096.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,047.89
|
|
|
PR LIGATION MAJOR ARTERY EXTREMITY
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 37618
|
| Min. Negotiated Rate |
$366.65 |
| Max. Negotiated Rate |
$564.40 |
| Rate for Payer: AlohaCare Medicaid |
$390.55
|
| Rate for Payer: AlohaCare Medicare |
$366.65
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Devoted Health Medicare |
$403.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$366.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$387.40
|
| Rate for Payer: Health Management Network Commercial |
$564.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$439.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$439.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$439.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$390.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$366.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$390.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$366.65
|
|
|
PR LIGATION OF COMMON ILIAC VEIN
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
HCPCS 37660
|
| Min. Negotiated Rate |
$481.78 |
| Max. Negotiated Rate |
$1,864.90 |
| Rate for Payer: AlohaCare Medicaid |
$1,281.23
|
| Rate for Payer: AlohaCare Medicare |
$1,180.19
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Devoted Health Medicare |
$1,298.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,180.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$481.78
|
| Rate for Payer: Health Management Network Commercial |
$1,864.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,416.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,416.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,416.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,281.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,180.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,281.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,180.19
|
|
|
PR LIGATION OF FEMORAL VEIN
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 37650
|
| Min. Negotiated Rate |
$268.58 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: AlohaCare Medicaid |
$435.23
|
| Rate for Payer: AlohaCare Medicare |
$404.33
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Devoted Health Medicare |
$444.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$404.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.58
|
| Rate for Payer: Health Management Network Commercial |
$633.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$485.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$485.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$485.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$404.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$404.33
|
|
|
PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 37607
|
| Min. Negotiated Rate |
$273.52 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: AlohaCare Medicaid |
$363.04
|
| Rate for Payer: AlohaCare Medicare |
$337.99
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Devoted Health Medicare |
$371.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$337.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$273.52
|
| Rate for Payer: Health Management Network Commercial |
$527.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$405.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$363.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$337.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$363.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$337.99
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
HCPCS 37735
|
| Min. Negotiated Rate |
$508.86 |
| Max. Negotiated Rate |
$798.15 |
| Rate for Payer: AlohaCare Medicaid |
$549.60
|
| Rate for Payer: AlohaCare Medicare |
$508.86
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Devoted Health Medicare |
$559.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$508.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$558.74
|
| Rate for Payer: Health Management Network Commercial |
$798.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$610.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$610.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$610.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$549.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$508.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$549.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$508.86
|
|
|
PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 37700
|
| Min. Negotiated Rate |
$224.27 |
| Max. Negotiated Rate |
$361.47 |
| Rate for Payer: AlohaCare Medicaid |
$240.13
|
| Rate for Payer: AlohaCare Medicare |
$224.27
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Devoted Health Medicare |
$246.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$361.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$224.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$289.12
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$269.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$224.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$224.27
|
|
|
PR LIG DIV & STRIPPING SHORT SAPHENOUS VEIN
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 37718
|
| Min. Negotiated Rate |
$347.82 |
| Max. Negotiated Rate |
$544.85 |
| Rate for Payer: AlohaCare Medicaid |
$374.24
|
| Rate for Payer: AlohaCare Medicare |
$347.82
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Devoted Health Medicare |
$382.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$347.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$402.22
|
| Rate for Payer: Health Management Network Commercial |
$544.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$417.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$417.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$417.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$374.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$347.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$374.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$347.82
|
|
|
PR LIG DIV&STRPG LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$407.86 |
| Max. Negotiated Rate |
$635.80 |
| Rate for Payer: AlohaCare Medicaid |
$441.11
|
| Rate for Payer: AlohaCare Medicare |
$407.86
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Devoted Health Medicare |
$448.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$407.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.42
|
| Rate for Payer: Health Management Network Commercial |
$635.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$489.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$489.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$441.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$407.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$441.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$407.86
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$610.59
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: AlohaCare Medicaid |
$251.44
|
| Rate for Payer: AlohaCare Medicare |
$230.80
|
| Rate for Payer: Cash Price |
$366.35
|
| Rate for Payer: Cash Price |
$366.35
|
| Rate for Payer: Devoted Health Medicare |
$253.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$251.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$400.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$251.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$222.30
|
| Rate for Payer: Health Management Network Commercial |
$519.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$276.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$251.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$251.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.80
|
| Rate for Payer: University Health Alliance Commercial |
$350.00
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$160.68 |
| Max. Negotiated Rate |
$333.20 |
| Rate for Payer: AlohaCare Medicaid |
$229.44
|
| Rate for Payer: AlohaCare Medicare |
$215.05
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Devoted Health Medicare |
$236.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.68
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$229.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.05
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: AlohaCare Medicare |
$63.13
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Devoted Health Medicare |
$69.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.42
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.13
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$281.84 |
| Max. Negotiated Rate |
$499.80 |
| Rate for Payer: AlohaCare Medicaid |
$346.70
|
| Rate for Payer: AlohaCare Medicare |
$303.16
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Devoted Health Medicare |
$333.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.84
|
| Rate for Payer: Health Management Network Commercial |
$499.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$363.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$363.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$346.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$303.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$346.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.16
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$677.45 |
| Rate for Payer: AlohaCare Medicaid |
$465.32
|
| Rate for Payer: AlohaCare Medicare |
$408.34
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Devoted Health Medicare |
$449.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$408.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.42
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$490.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$490.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$490.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$408.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$465.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$408.34
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,649.18
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$300.20 |
| Max. Negotiated Rate |
$1,401.80 |
| Rate for Payer: AlohaCare Medicaid |
$340.99
|
| Rate for Payer: AlohaCare Medicare |
$300.20
|
| Rate for Payer: Cash Price |
$989.51
|
| Rate for Payer: Cash Price |
$989.51
|
| Rate for Payer: Devoted Health Medicare |
$330.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$340.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$530.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$300.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$340.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$495.04
|
| Rate for Payer: Health Management Network Commercial |
$1,401.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$360.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$360.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$340.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.20
|
|
